Symptoms of Sinus Infections
Sinus infections present with a constellation of symptoms including purulent nasal discharge, nasal congestion, facial pain, postnasal drainage, headache, and cough, with the duration and severity of symptoms distinguishing acute from chronic disease. 1
Cardinal Symptoms of Acute Sinusitis
The most prominent symptoms that should raise suspicion for acute bacterial sinusitis include:
- Purulent rhinorrhea (thick, discolored nasal discharge) 1
- Nasal congestion and obstruction 1
- Facial or dental pain and pressure, particularly unilateral 1, 2
- Postnasal drainage with purulent secretions 1
- Headache, often localized over affected sinuses 1
- Cough, frequently worse at night 1
- Fever (particularly when >102°F/39°C, which strongly suggests bacterial infection) 1, 2
A key clinical indicator is persistent upper respiratory symptoms lasting 10-14 days without improvement, which distinguishes bacterial sinusitis from viral upper respiratory infections that typically resolve within 7-10 days. 1, 2
Additional Associated Symptoms
Beyond the cardinal features, patients may experience:
- Anosmia (loss of smell) 1
- Halitosis (bad breath) 1
- Fatigue and malaise 1, 3
- Sore throat from postnasal drainage 1
- Nausea in some cases 1
- Hyposmia (reduced sense of smell) 1
In children specifically, acute sinusitis may also manifest as increased irritability, prolonged cough, and vomiting associated with gagging on mucus. 1
Chronic Sinusitis Symptoms
Chronic sinusitis presents with similar but often more subtle and insidious symptoms lasting 8 weeks or longer. 1
Key differences from acute sinusitis include:
- Pain is much less prominent in chronic disease 1
- Symptoms may be vague or minimal, making diagnosis more challenging 1
- Patients may only perceive a mild increase in baseline congestion and fatigue 1
- Abnormal CT or MRI findings should be present to confirm chronic sinusitis diagnosis 1
Clinical Classification by Duration
The American Academy of Allergy, Asthma, and Immunology provides this temporal classification: 1
- Acute sinusitis: Symptoms <4 weeks
- Subacute sinusitis: Symptoms 4-8 weeks (unresolved acute)
- Chronic sinusitis: Symptoms ≥8 weeks
- Recurrent sinusitis: ≥3 episodes of acute sinusitis per year
Physical Examination Findings
Clinical signs that support the diagnosis include:
- Sinus tenderness on palpation over affected areas 1
- Mucosal erythema and edema on nasal examination 1
- Purulent nasal secretions visible in nasal passages 1
- Periorbital edema or dark circles beneath eyes 1
- Purulent material in posterior pharynx 1
- Pharyngeal erythema and lymphoid hyperplasia 1
Critical Warning Signs Requiring Urgent Evaluation
Any patient presenting with orbital swelling or pain, forehead swelling, or diplopia requires urgent evaluation for potential complications such as orbital cellulitis, meningitis, or abscess. 1, 2 These complications are rare but potentially life-threatening and warrant immediate CT imaging and specialist consultation. 2, 4
Important Clinical Pitfalls
A common diagnostic challenge is distinguishing bacterial sinusitis from viral upper respiratory infections or allergic rhinitis, as symptom overlap is substantial. 1 The critical distinguishing features are symptom duration beyond 10-14 days, severe symptoms with high fever and purulent discharge, or significant worsening after initial improvement. 1, 2
Note that rhinitis typically precedes sinusitis, and sinusitis without rhinitis is rare, which is why the term "rhinosinusitis" is increasingly preferred. 1